Acceptability of tongue swabs for tuberculosis screening in migrant settings in northern Italy: A qualitative study

Human migrations, driven by economic hardship, conflict, and climate change, complicate the global fight against tuberculosis (TB). New strategies are needed to improve the screening of migrants for active TB disease. Current sputum-based testing methods are logistically challenging in many settings. Alternative sampling with tongue swabs is designed to be easier than sputum collection and exhibits acceptable accuracy. This study characterized the acceptability of supervised self-swabbing (SSS) for TB screening in migrant settings in Northern Italy.Migrants arriving through the Central Mediterranean route to Italy were purposely sampled to participate in in-depth interviews (IDIs), which were conducted with the support of a cultural mediator. Data was analyzed using a rapid qualitative analysis approach. The Capability, Opportunity, Motivation-Behavior (COM-B) model guided the systematic assessment of potential barriers and facilitators to SSS. Between November 2023 and June 2024, we conducted 24 IDIs with migrant men and women. Most participants preferred SSS over sputum production and found it relatively easy. Reasons for preferring SSS included its simplicity, privacy, and aversion to sputum collection. Discomfort during swabbing was rare. However, a few participants preferred sputum collection and cited oral hygiene-related complications. Participants highlighted language barriers, trust deficits with the healthcare system, and limited health literacy on infectious diseases, including TB, as factors that could limit the uptake of SSS. Participants also reported that their willingness to participate in TB screening may be driven by a need to comply with immigration rules. SSS is a promising and acceptable method for collecting samples for TB screening. To strengthen TB mitigation strategies in this population, future efforts should focus on developing culturally and linguistically tailored educational materials that address the specific concerns and informational needs of migrants.